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FOR SERVICE CALL: SERVICE ORDER FORM NO. WOES004-B(8/18) <br /> DIXON OFFICE ASBURY ENVIRONMENTAL SERVICES, DBA SERVICE ORDER NO. <br /> 1-800-727-2879 <br /> FOR ACCOUNTING CALL: 3842135 <br /> 562-231-1550 ()WORLDOIL <br /> ENVIRONMENTAL SERVICESTM <br /> S 7300 CHEVRON WAY, DIXON,CA 95620 <br /> " SPEEDEE OIL CHANGE 1-800-727-2879 <br /> P <br /> 245 W LOUISE AVE 245 W LOUISE AVE <br /> P WWW.WORLDOILCORP.COM <br /> D TRANSPORTER EPA#CAD028277036 <br /> T MANTECA,CA 95336 MANTECA, CA 95336 <br /> (209) 825-5823 (209) 825-5823 <br /> CUSTOMER# PURCHASE ORDER# ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> SPE080 ER-86 Z0/ ADAM SCHEDULED-1 <br /> DATE REQUIRED DATE ENTERED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADING/MANIFEST# <br /> pe - <br /> 1/14/2022 1/5/2022 CAL000351460 <br /> PART# DESCRIPTION QTY UNIT PRICE QTY P/U wTCTAL <br /> OFDR OIL FILTER DRUM REPLACEMENT- NO CHARGE 2 $0.00 $0.00 <br /> PF PAPER F=ILTERS PER DRUM 2 $85.00 $170.00 <br /> BATCH <br /> TOTAL <br /> CASH REC'D: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE, LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> IL OTHER: NQN-RnRA HA7ARnni is%AiASTF _Roi in(Oil Y PAPES1PI ASrin Ell TFRS i DEB131U-tate Carie 35.2 <br /> X DESIGNATED TSDF: YES MANAGEMENT INC. 6500 US HIGHWAY 95 YUMA AZ 85365 <br /> ALTERNA, F: <br /> Cron Its: Account Manager: Sam Read <br /> DRUMS P U: EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION (PLEASE CHECK THE APPROPRIATE BOX) <br /> By signing below I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> J#1)1 have not mixed any of the waste described above with any other hazardous waste,the total halide content is LESS than 1,000 ppm,and the waste does not contain any PCBs.1 have <br /> complied with the requirements of the applicable California used oil management regulations to determine this is true.I agree to accept the additional charges for the disposal of this waste if <br /> the information I have provided about this waste is incorrect <br /> J#2 1 have not mixed any of the waste described above with any other hazardous waste,the total halide content is GREATER than 1,000 ppm,and the waste does not contain any PCBs.1 <br /> have provided proper documentation to World Oil Environmental Services to rebut the presumption that this waste was mixed with other hazardous waste.1 agree to accept the additional <br /> charges for the disposal of this waste if the information I have provided about this waste is incorrect <br /> J#3)This waste is from a tank which collects waste oil from household"do-it-yourself"(DIY)and/or conditionally exempt small quantity generator(CESOG)sources.To the best of my <br /> knowledge,the only waste oil contained in my DIY/CESOG collection tank is soley from DIY and/or CESOG sources.I have not mixed this waste oil with any other hazardous waste or waste oil <br /> from other sources.1 agree to accept the additional charges for disposal of this waste if the information I have provided about this waste is incorrect <br /> (All generators/customers MUST read the following text <br /> I certify that 1 have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically practicable and that I have selected the <br /> practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human life and the environment. <br /> This individual signing in the space set forth below on behalf of customer represents and warrants that he)she has the authority to bind customer,that the forgoing descriptions of waste <br /> and materials are true and accurate as packaged,marked,and labeled,are ready for transportation in accordance with applicable state and federal regulations,and that customer shall abide <br /> by the Standard Terms and Conditions on the reverse side of this Service Order. <br /> Service Orders with an associated hazardous waste manifest(either site specific or consolidated)are subject to an EPAFee. These f the EPA pass-through fee and administration <br /> of the eManifest program. These fees vary based on Manifest type. Applicable fees will appear on your billing Invoice. <br /> Customer Signature Date triver--- nature Date <br /> fad: (16� A-" <br /> Print Name Pnnt Driver Name <br />